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Issue Alert - New Guidelines from Social Securtity regarding disability assessments related to Flint water crisis

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Date:

Jun 03, 2016

Program Area:

Social Security Administration Disability Benefits - Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI)

Issue Summary:

The Social Security Administration has provided some guidance on medical evidence and impairments that may result from ingesting toxic lead, for individuals applying for SSI or SSDI benefits based on an allegation of impairment due to lead contaminated water in Flint, MI.

Persons Affected:

Adults or children applying for SSI or SSDI benefits based on an allegation of impairment due to lead contaminated water in Flint, MI.

For More Information:

Veronica “Nickie” Perera
Center for Civil Justice
436 S. Saginaw St., Suite 400
Flint, MI 48502
(810) 244-8044
vperera@ccj-mi.org
Lisa Ruby
Michigan Poverty Law Program
220 E. Huron #600A
Ann Arbor, MI 48104
(734) 998-6100 ext. 117
lruby@mplp.org


Background

In April 2014, Flint, MI, changed its water source from the Detroit Water and Sewerage Department (DWSD) to the Flint River. Corrosive water from the Flint River caused lead from aging water pipes to leach into the water supply. Estimates are that this exposed thousands of Flint residents to unsafe levels of lead in the water supply. On May 17, 2016, the Social Security Administration (SSA) issued an emergency message, providing some guidance on medical evidence and impairments that may result from ingesting toxic lead for individuals applying for SSI or SSDI benefits based on an allegation of impairment due to the lead contaminated water.

 

 

What's Happening?

Advocates may begin to see adults or children who have been exposed to lead contaminated water in Flint, MI, apply for SSI or SSDI, based on allegations that they have developed health impairments due to the unsafe lead levels in their water. SSA will be flagging all cases that allege an impairment due to water contamination in Flint; however, the flag is for tracking and data collection purposes only. No special treatment will be given to applications related to the Flint water.

The determination of whether or not an individual meets the criteria for SSI or SSDI benefits is made by the Disability Determinations Services (DDS). DDS uses criteria laid out in SSA’s “Listing of Impairments to determine whether an individual is disabled.  At the time of this writing, there is no official listing for lead poisoning for children or adults. The emergency message issued by SSA on May 17, 2016, (summarized below) provides an idea of what criteria might be considered and what type of medical evidence may be useful to a claim of disability based on lead poisoning.

 

1.    Lead is a highly toxic metal that can cause many health problems when ingested or inhaled. The definitive test for lead exposure is a blood lead level (BLL) test. Results are reported in micrograms per deciliter (μg/dL). An elevated BLL is defined as a BLL of 5 μg/dL or greater in a venous blood sample.

 

2.    Lead can produce adverse effects on virtually every system in the body; it can damage:

○     the kidneys,

○     the nervous system,

○     the reproductive system, and

○     the cardiovascular system.

 

3.    It is especially harmful to the developing brains of fetuses and young children. Fetuses, infants, and children under age 5 are at the highest level of risk for irreversible problems resulting from lead poisoning. Adverse effects can occur at low levels of exposure and BLLs do not have to remain persistently high over a certain period for the harmful effects to be permanent.

 

4.    Adults can experience the same symptoms as children can; however, most adults can tolerate higher blood levels of lead than children and are more likely to have reversible effects once exposure stops. As with most toxic substances, the higher level of exposure and the longer the exposure, the greater degree of irreversibility is expected

 

5.    In children, signs and symptoms of the long-term effects of lead exposure and elevated BLLs include:

○     learning and memory problems,

○     decreased verbal abilities,

○     impaired speech and hearing,

○     behavioral problems,

○     hyperactivity,

○     and attention deficit hyperactivity disorder (ADHD).

 

6.    Other symptoms can include:

○     myalgias or paresthesias,

○     fatigue,

○     irritability,

○     lethargy, and

○     abdominal pain.

 

7.    Moderate exposure signs and symptoms include:

○     general fatigue,

○     difficulty concentrating,

○     muscular exhaustibility,

○     tremor,

○     headache,

○     abdominal pain,

○     vomiting,

○     constipation, and

○     weight loss.

 

8.    Some other long-term effects of exposure to high levels of lead are:

○     kidney disease,

○     increased risk of hypertension, and

○     increased risk of gout.

 

 

What Should Advocates Do?

Advocates can assist clients in gathering appropriate medical evidence. When evaluating disability claims related to lead contaminated water, DDS the will consider the following:

 

a.    DDS may request Blood Lead Levels (BLLs) for claimants alleging impairments resulting from lead exposure. BLLs provide information about level of exposure, and with time, evidence of decreasing blood levels with removal of lead exposure and treatment. Blood levels can provide DDS adjudicators with some indication of possible severity; however, to determine whether an individual is eligible for benefits, DDS will focus on evaluation of the claimant’s alleged limitations arising from lead exposure.

 

b.    If the client has had cognitive testing, hearing, and/or speech screenings, which may be administered by a school or other agency, such information should be made available as part of a claimant’s school or medical record. If this testing is not available from the school or public health entities or if an adult is experiencing cognitive or sensory effects secondary to lead exposure and has not had testing, request a consultative examination from DDS for cognitive testing, hearing, or speech evaluations.

 

 

c.    A mental status examination may be appropriate where there are indications of related behavioral problems, depression, anxiety, or post-traumatic stress disorder (PTSD), especially considering the magnitude of the public health event. If the client is unable to obtain an exam, request a consultative examination from DDS.

What Should Clients Do?

1.    If you or your child are applying for disability benefits from SSA for an impairment resulting from exposure to lead contaminated water in Flint, indicate in on the application that you believe that you or your child were exposed to unsafe water in Flint, MI.

 

2.    Obtain a blood lead level test. If you or your child are unable to obtain a test from your primary care physician or your child’s school, blood lead level tests are available at no or low cost from many public health entities, including the Genesee County Health Department, 810-257-3445, http://www.gchd.us/other_services/lead_testing.php.

 

3.    If you think you or your child may be experiencing difficulty with awareness, perception, reasoning, or judgment, obtain cognitive testing. If you think you or your child may be experiencing difficulty with hearing or speech, obtain hearing and/or speech screenings or testing. If this testing is not available from your doctor, your child’s school, or public health entities, or if you are an adult who is experiencing cognitive or sensory effects secondary to lead exposure and has not had testing, request a consultative examination from DDS for cognitive testing, hearing, or speech evaluations.

 

4.    If you think you may be experiencing behavioral problems, depression, anxiety, or post-traumatic stress disorder (PTSD), obtain a mental health examination from your doctor or your local public health entity. If you are unable to obtain a mental health exam, request a consultative examination from DDS.

 

 

5.    Your local Legal Aid office is also a good source for advice and possible representation. You can find contact information for your local office at http://michiganlegalhelp.org/.

 

Sources

 

 

Social Security Administration, Emergency Message 1018,”Disability Claims Potentially Associated with Flint, Michigan (MI) Water Supply Contamination – Instructions will follow shortly”  effective date: 05/17/16, https://secure.ssa.gov/apps10/reference.nsf/links/05172016100919AM.

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee. You can locate various sources of legal and related services, including the free legal aid office that serves your county, at MichiganLegalAid.org. You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.
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